1487572434 NPI number — MR. KEVIN B JOHNSON CRANIAL PROSTHESIS

Table of content: MR. KEVIN B JOHNSON CRANIAL PROSTHESIS (NPI 1487572434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487572434 NPI number — MR. KEVIN B JOHNSON CRANIAL PROSTHESIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
KEVIN
Provider Middle Name:
B
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CRANIAL PROSTHESIS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487572434
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2569 COUNTRYSIDE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33761-3581
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-460-1221
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2569 COUNTRYSIDE BLVD
Provider Second Line Business Practice Location Address:
BUILDING 20 SUITE 127
Provider Business Practice Location Address City Name:
CLEARWATER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-408-9049
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2026

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 224P00000X , with the licence number:  BB8897104 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com